Personal Care at Home Bill

My Lords, I will reply to the group which comprises Amendments 19, 32, 33, 37 and 42. I have taken out about two-thirds of my notes because I am conscious of the time, so if I seem a bit truncated that is because I am. I start by saying that the proposals in this Bill are for England and are not the same as they are in Scotland. In Scotland they offer a much different system, which is about the provision of full care free of charge, not personal care, as we are proposing, which is a much more targeted approach. The Government entirely agree that a range of services and support needs to be available to help people to maintain their independence and, crucially, to help prevent their care needs from increasing. We know, for instance, that an older person who is losing some of their mobility, but is otherwise capable of looking after themselves, can be helped by the provision of home adaptations to continue living independently in their own home. As well as these sorts of adaptations, early intervention and support services, such as balance training to help someone recovering from a fall, are known to be a worthwhile investment which both helps people to get back on their feet and continue living independently, and saves money in terms of preventing admissions or readmissions to hospital or residential care. We know that prevention and early intervention are not only good for people but make absolute economic sense. However, we are not starting from scratch. The Government have been promoting and supporting this approach in a variety of ways. In the Putting People First programme we defined prevention as one of the essential elements of what a transformed social care service for adults would look like. We have given local authorities more than £500 million to support that transformation and, all around the country, have been developing preventive services to support people’s independence. Where this involves adaptations to the home, it is often done in partnership with housing providers, who can draw on disabled facilities grants. The allocations for 2010-11 will be announced shortly. We have also specifically promoted the development of telecare and other technologies through the £80 million preventive technologies grant made some years ago. On top of this, the Bill offers further support for reablement services, which include home adaptations and technologies. We are not just talking about the amount of money allocated by the activities of this Bill, but about building on other resources which are already available for adaptations to people’s homes. Amendment 19, moved by the noble Earl, Lord Howe, seeks to insert a power for the definition of personal care to be included in the regulations. Of course, the noble Earl is right: it is necessary that we clarify our definition of personal care but it is not necessary to do so in the Bill. The definition is in the working draft, which reflects our current thinking. It may be subject to change following the close of the stakeholder consultation tomorrow and our review of the responses. I ask the noble Earl to withdraw his amendment on the basis that we will include a definition of personal care in regulations, as indicated in the current working draft. Amendment 32, tabled by the noble Lord, Lord Best, raises several different issues. The first part of the amendment would require regulations to give local authorities the power to assess the suitability of an individual’s home for independent living where they have been determined to be eligible to receive free personal care at home. Clearly, it is important that, while many people wish to stay in their homes for as long as possible, they should not be living in an inappropriate setting. We would expect councils to look at the impact that suitable alternative housing or adaptation would have on helping to keep people in their homes. We completely agree with the noble Lord about both the importance of housing and the necessity of including it in the assessment. We would expect local authorities to check whether there are any needs that could be helped by aids and adaptations or additional services when they carry out their community care assessment. That is one of the reasons why we include reablement in these proposals—to encourage councils to think more broadly about the type and range of support that they should provide. The second part of the amendment refers to the need for personal care to include the provision of aids and adaptations. I think I mentioned our view on this in my previous remarks on this amendment. We agree with the noble Lord. I turn now to Amendment 33. In the draft regulations, which we have made available to Peers, we have set out the eligibility criteria which we propose will determine who has the highest care needs and will qualify for free personal care. Our proposals require that, to be counted as having the highest needs, a person must first be within the Fair Access to Care "critical" band, and—as we have proposed and already discussed—need significant help when prompted to carry out four or more activities of daily living. The noble Baroness, Lady Greengross, is rightly concerned that any assessment of a person’s ability to carry out activities of daily living should be able to capture whether they have difficulty because they need prompting in addition to any physical difficulty that they have. I reassure the noble Baroness and the noble Baroness, Lady Barker, who voiced their concerns on this matter, that, as part of our wider discussions with stakeholders, the regulations will need to cover supervision and prompting in relation to daily activities as part of the eligibility criteria. Amendment 37 tabled by the noble Baroness, Lady Barker, would insert a requirement for local authorities to ensure that staff have an "understanding of dementia" when delivering personal care to those with a dementia diagnosis. The noble Baroness and the House will know that the Government have already taken major steps to transform the quality of care for those with dementia through our strategy and through the start we have made in building on that strategy. Section 15 of the Community Care (Delayed Discharges etc.) Act 2003, which the Bill amends, is about the free provision of services and not about particular types of service provision. The guidance accompanying the regulations enabled by the Bill will need to consider how local authorities may best ensure the delivery of free personal social care at home and ensure that it takes into account the Dementia Strategy. We think it is unsuitable to place this in the Bill, but we completely take on board the concern raised by the noble Baronesses, Lady Barker and Lady Greengross, on this issue. We are absolutely in sympathy with it. Amendment 42 by the noble Baroness, Lady Barker, inserts the definition of personal care into the Bill. As I have already said, the definition of personal care is included in the consultation document which is currently open for comment. We have been working with stakeholders to ensure that this definition is accurate and appropriate and meeting the Bill’s aim of providing personal care to those with the highest needs. Following our analysis of that consultation we will look to amend the definition of personal care that we have set out in our working draft. However, we do not believe it is appropriate to put this in the Bill. We ask the noble Baroness to withdraw the amendment.